SALT LAKE CITY — Those who have ever waited a long and painful time for broken ribs to heal will remember the drill well.
The patient, injured in a fall or an accident, comes into the emergency room with several broken ribs. The doctor evaluates the images of the fractures, making sure there's no additional damage. He prescribes pain medication and rest and tells the patient (even though it hurts) to avoid restricting the mechanics of breathing, which keeps the lungs from collapsing.
This recipe for repair is what Ken Manzanares was facing after the horse he was riding slipped out from under him on a slippery canyon trail. He slammed against an embankment, breaking five ribs. Trauma surgeon Don Van Borum at the Intermountain Medical Center showed Manzanares the X-ray.
"They were displaced in such a way that I risked losing my breathing capacity," Manzanares said. "And the mending," he added, "may not be what I wanted."
Allowing displaced bones to heal on their own is not only uncomfortable but often risky. Some patients never fully recover, while others become addicted to the pain medications. Many require a breathing machine for two weeks or longer.
Dr. Van Borum says, "This seems crazy that people will still go through this when there's an alternative to getting someone off the breathing machine and out of the hospital sooner."
"Recovery is rapid. Most patients are out of the hospital in four to five days. That seems average."
Manzanares opted for the alternative: a new approach called "rib plating." Through small incisions at the break sites, Dr. Van Borum spanned the broken ribs with tailor made titanium plates, holding them in place with locking screws.
While the technology is similar to mending legs or arms, the novel rib plates mimic the ribs. They move while you breathe, but hold firm at the site of the break.
"Recovery is rapid. Most patients are out of the hospital in four to five days," Van Borum said. "That seems average."
Immediately following the surgery, Manzanares felt no rib pain. And instead of what could have been as much as four to six months of slow healing, he was back to work within a few weeks.
According to Manzanares, "I feel no pain. I have no issues. I do hard labor now pouring concrete as part of my job with Salt Lake County."
Manzanares is now fully involved with the hobby he loves: rebuilding classic saddles. As far as riding in that saddle again? "Within a month," he said. "I was probably back on a horse within a month."
Surgeons at Intermountain Medical Center are working with other hospitals around the country, sharing what could be the most comprehensive data collected so far on rib plating. They're also refining the technology, hoping to make it even less invasive than it is now.